Is PRP an effective, new Tennis Elbow treatment - Or an overpriced fad, driven by star-athlete publicity and marginal science?
Platelet-Rich Plasma (PRP) therapy certainly looks like it could be a promising, new treatment approach to stubborn, chronic tendon problems, like Golfer's Elbow and Tennis Elbow.
And, along with its lessor relative, Autologous Blood Injection (ABI) it has excellent upsides: It's a quick procedure; minimally invasive; uses your own cells – not some toxic drug – and is unlikely to have any major negative effects.
Compared to nearly ever other medical intervention for Tennis and Golfer's Elbow (and other Tendinopathies) I would really like to be positive about this one. I certainly like the theory behind it!
(I'm negative about almost all the conventional Tennis and Golfer's Elbow treatment approaches, as you can see on this blog, for very good reasons, so it's nice to be able to say something positive.)
See my video: comparing the standard treatment approach to the Tennis Elbow Classroom strategy.
But, the question is, will PRP prove to be an effective, reliable remedy backed by scientific evidence or will it turn out to be just another expensive, overrated fad?
Some say the writing is already on the wall – Others say it's still too early to tell. So let's take a look at what PRP is, how it's supposed to work and, finally, I'll weigh in with my two cents.
Table Of Contents Of This Article:
(Links jump down the page to various sections of this article.)
- What is Platelet-Rich Plasma Therapy?
- What's the difference between PRP and Autologous Blood (ABI) Injection?
- How does it work? What's the theory behind PRP and ABI?
- Is PRP an effective treatment for Tennis Elbow and Golfer's Elbow?
- What's my opinion as a practitioner who specializes in treating Tennis Elbow?
Podcast Version On The PRP Question
In this podcast episode I discuss the pros and cons of Platelet-Rich Plasma Therapy. (It's actually the same as the video above.) Scroll down for the podcast subscribe link.
Here's the downloadable version of this podcast you can keep by clicking the "download" link under the player below - And please subscribe on your favorite platform:
What Is Platelet-Rich Plasma Therapy?
PRP therapy is an in-office “non-surgical” procedure (they say “non-surgical” - but I would classify it as a minor surgery) that begins by having a small amount of your own blood drawn.
Your blood is then spun in a centrifuge to concentrate the platelets in it (which also separates them from your red and white blood cells.)
In the photo below Dr. Allan K. Mishra, Orthopedist at Stanford University's Menlo Clinic in Menlo Park, California, holds up and displays a tube containing centrifuged blood.
Next, your platelets along with some of your plasma are injecting back into your body in the area that has the injury that isn't healing well.
Platelets are the cells in the blood that are mostly responsible for blood clotting, and platelets also secrete growth factors (including human growth hormone) that are involved in tissue healing.
In the case of Tennis Elbow or Golfer's Elbow, your Platelet-Rich Plasma is injected into either your Wrist Extensor Tendon Origin at your Lateral Epicondyle (the Tennis Elbow “spot”) or your Flexor Origin on the medial side (the Golfer's Elbow “spot.”)
Podcast: Doctor's Interview Explaining Theory And History Of PRP
Here's a short podcast from NPR with host, Robert Siegel, interviewing Dennis Cardone, Assoc. Prof. of Orthopedic Surgery at NYU's Langone Medical Center, who explains the basic theory of how PRP works, the story of how it became so popular and questions its effectiveness:
"There are some studies out, but let's just say that the evidence is not as good as we would like it to be. So, we'd like to see more of the double-blind randomized control, better-evidenced based studies."
NPR Podcast: Platelet-Rich Plasma Therapy Explained
What your Doctor may not tell you in advance is that they jab that needle into your tendon in not just one spot, but in several different places (up do a dozen?)
I've heard from a few of my patients, personally, and several people commenting on my Facebook page and in my members forum, that the process can be very, very painful!
(For some reason some Doctors apparently don't use any local anesthetic when they give you these injections – which can be excruciating – but even if they do anesthetize you during the procedure, I hear it can still hurt like hell for days afterward.)
How Does PRP Differ From Autologous Blood Injection? (ABI)
The main difference between Autologous Blood Injection (ABI) and PRP is that they don't take the step of centrifuging your blood to concentrate the platelets first before injecting it back into your tendon(s.)(Autologous simply means cells or tissues obtained from the same person.)
The platelets are still there, just not in as high a concentration as with PRP.
The advantage is that Autologous Blood Injection treatments are usually a lot less expensive that PRP treatments.
PRP treatments run from around $500. to as much as $2000. per visit, and sometimes multiple visits are required.
And no known insurer covers PRP or ABI injection treatments, as there isn't enough evidence, via medical studies, (which we'll get to shortly.)
I can't find a good source for the price range of ABI treatments. My guess would be that it varies even more that PRP from clinic to clinic and city to city but my impression is that the savings are substantial.
It's much more low tech considering that it's basically just “blood out over here – then back in over there” hopefully guided by ultrasound, though.
How Do These Blood Injection Therapies Work? - What's The Goal And The Theory Behind Them?
The objective of PRP of ABI is to use your body's own cells, proteins and healing factors to stimulate and start (or re-start) a healing process in your tendon(s.)
To kick-start healing that has either stalled and remained incomplete or never started in the first place, and that begins with inflammation.
Yes! You read that correctly. To instigate a healing response, which always begins with inflammation.
Probably the most fascinating thing to me about PRP is the radical reversal from the standard anti-inflammatory medical approach to Tennis Elbow.
Instead of fighting inflammation – They are finally encouraging it! (Although they often seem to be a little vague about that key point.)
Why? Is it because up until that point they've been busy telling you to fight your inflammation, and have been busy selling you pills, lotions and creams and Cortisone shots?
For decades, Doctors, medical websites, trainers and Physical Therapists have emphatically instructed Tennis Elbow, Golfer's Elbow and other tendon injury sufferers to treat or “manage” their inflammation.
(As if your body possessed no self-regulation and didn't know what the proper inflammatory response to an injury should be and, hence, like a recalcitrant, new puppy, necessitating constant micromanagement by way of pills, ice and shots.)
Unfortunately, most STILL DO advise you to take this faulty “treat and defeat inflammation” approach for weeks or months on end before trying something else…
But how much damage is done during that time by fighting and suppressing one's own natural healing process!?
Now it's FINALLY being recognized by top authorities in Sports Medicine, Athletic Training and other disciplines that inflammation is not the villain it has been made out to be.
Here's one recent study where the doctors authoring the study acknowledge that the typical, common wisdom treatments, like anti-inflammatories, (NSAIDs) Cortisone shots – and let's not forget ICE! – Don't work, because they can't overcome the tendon's poor blood supply and innate tendency to “resist” healing...
AND that the goal of these types of treatment, including Prolotherapy and PRP is to induce – NOT suppress – inflammation!
“Epicondylitis was initially believed to be an inflammatory process but in 1979, it was described as the disorganization of normal collagen architecture...”
“The effectiveness of oral nonsteroidal anti-inflammatory agents, topical and injectable medications including corticosteroids and botulinum toxins, splinting, physical therapy, and iontophoresis has been evaluated in many studies...”
“However, these traditional therapies do not alter the tendon's inherent poor healing properties secondary to poor vascularization.”
“Given the inherent nature of the tendon, new treatment options including platelets rich plasma (PRP), autologous blood, and prolotherapy are aimed at inducing inflammation rather than suppressing it.”
Pain Res Treat. 2014; 2014: 191525 - Seyed Ahmad Raeissadat, et al.
'Effect of Platelet-Rich Plasma (PRP) versus Autologous Whole Blood on Pain and Function Improvement in Tennis Elbow: A Randomized Clinical Trial'
As I've been saying for over a decade, inflammation is a necessary and normal part of the healing process of injured tissue so, stop fighting it!
See my post and video Tossing The Tendonitis Myth about why Tennis Elbow is NOT Inflammatory
We have to correct the myth and faulty model of Tennis Elbow that falsely accuses inflammation of being the cause of the problem, (which becomes absurdly illogical, once you learn that inflammation is a normal part of the healing process)…
But that's only if the healing process is working – or allowed to work – and it's not suppressed by icing, anti-inflammatory medications and the absolute worst culprit: Cortisone.
Video Explaining The Theory Of How PRP Works For Tennis Elbow
What we have in most cases of truly chronic Tennis or Golfer's Elbow is a tendon or tendons that have failed to heal – The tendon(s) have NOT undergone the proper inflammatory response and subsequent repair.
And these tendons have instead gradually slipped into a degenerative breakdown state known as Tendinosis. (And sometimes there is some degree of tearing in the tendon or its attachment.)
The intention with PRP is to reverse this backward slide and re-energize the healing process through the injection of the platelets (and their healing factors) from ones own blood into the site – which kicks off a significant inflammatory response!
The traumatic process of repeatedly “stabbing” the needle into several areas of the tendon (which, by itself, would be referred to as 'Fenestration' – a technique that may have been pioneered on horses) may also help by bringing new blood into the area and triggering healing all by itself.
And, apparently, if things go as expected, it will be very painful for several days as the areas becomes inflamed. Multiple injections are often required, spaced over several weeks, months or whatever the Doctor thinks is best.
See also my article / video on Dry Needling – one form of which is basically like PRP and Prolotherapy – only without injecting anything.
Is PRP Effective For Tennis And Golfer's Elbow?
It seems that many medical studies have been done and many more are recruiting test patients and are underway right now. Some studies (many, but not all specific to Tennis Elbow) do show a positive result, but others show no significant result or none at all. Here are a few of them.
PRP And ABI Therapy Medical Studies With Positive Results
“Treatment of patients with chronic elbow tendinosis with buffered platelet-rich plasma reduced pain significantly in this pilot investigation. Further evaluation of this novel treatment is warranted.” [140 patients evaluated in study]
Am J Sports Med. 2006 Nov;34(11):1774-8 - Mishra A, Pavelko T.
Treatment Of Chronic Elbow Tendinosis With Buffered Platelet-Rich Plasma
Later, Dr. Allan Mishra, (lead author of the above study and seen in the photo in the NY Times article linked above) conducted a more comprehensive study of 230 patients with his colleagues:
“No significant differences were found at 12 weeks in this study. At 24 weeks, however, clinically meaningful improvements were found in patients treated with leukocyte-enriched PRP compared with an active control group.”
Here's a fast and easy breakdown of the 24-week results:
Improvements in patient pain scores:
Control group: 56.1% improvement
PRP group: 71.5% improvement
Percentage reporting significant elbow tenderness at 24 weeks:
Control group: 54.0%
PRP group: 29.1%
Success rates for patients at 24 weeks:
Control group: 68.3%
PRP group: 83.9%
Am J Sports Med. 2014 Feb;42(2):463-71 - Mishra AK, et al.
Efficacy Of Platelet-Rich Plasma For Chronic Tennis Elbow: A Double-Blind, Prospective, Multicenter, Randomized Controlled Trial Of 230 Patients
It's the largest and most specific study I've come across: One group in the study got an actual PRP injection, the other got a “sham injection,” meaning a needle inserted with nothing injected (as a placebo effect control group measure)
It's a meaningful and statistically-significant result, but how excited should one be about it?
The patients who were jabbed by a needle but got no injection improved by an average of at least 50% - Which can be attributed to the placebo effect or the effect of the needle alone.
('Dry Needling' or 'Fenestration' is a technique in and of itself.)
One of the things they point out, is that not all PRP preparations are the same, which might account for some of the variations in the findings of various studies.
In the next study, 40 patients with Tennis Elbow divided into 2 groups. One group got a PRP injection and the other got an autologous blood injection. The results seemed promising.
(I cited this study earlier, in reference to how the goal of the treatment is “aimed at inducing inflammation rather than suppressing it.”)
“PRP and autologous whole blood injections are both effective methods to treat chronic lateral epicondylitis.”
With PRP treatment coming out somewhat ahead in “relieving pain and improving function” at the 8-week followup.
Pain Res Treat. 2014; 2014: 191525 - Seyed Ahmad Raeissadat, et al.
Effect of Platelet-Rich Plasma (PRP) versus Autologous Whole Blood on Pain and Function Improvement in Tennis Elbow: A Randomized Clinical Trial
Unfortunately it looks like there was no control group (which would get an injection of simply salt water or nothing at all – as the placebo test / control) so it wasn't a “double blind” study.
“The limitation of our study was the relatively small number of cases included, absence of a control group receiving no intervention, and short-term follow-up evaluations.”
PRP And ABI Therapy Medical Studies With Flat Or Negative Results
“In this prospective, randomized, controlled trial, autologous blood, corticosteroid, and saline injection provide no advantage over placebo saline injections in the treatment of lateral epicondylitis.”
J Hand Surg Am. 2011 Aug;36(8):1269-72 - Wolf JM, et al.
Comparison Of Autologous Blood, Corticosteroid, And Saline Injection In The Treatment Of Lateral Epicondylitis: A Prospective, Randomized, Controlled Study
“There is strong evidence that PRP injections are not efficacious in the management of chronic lateral elbow tendinopathy.”
Br J Sports Med. 2014 Jun;48(12):952-6 - de Vos RJ, Windt J, Weir A.
Strong Evidence Against Platelet-Rich Plasma Injections For Chronic Lateral Epicondylar Tendinopathy: A Systematic Review
It seems that NPR is calling it "unproven" as of June 2014, quoting a French study that I could not access and little else:
“But randomized controlled trials like the French study are all over the map. As one 2012 review put it, rather tartly: 'The observed trend towards benefit with PRP use still remains questionable.'"
“One reason for the confusion may be that there's so much variation in the ways PRP is being used, including body part being treated, how the solution is prepared, how it's injected, and even the type of injury that's being addressed.”
Platelet-Rich Plasma Therapy Gains Fans, But Remains Unproven
And the New York Times also seems to be backing off their initial enthusiasm at this point as well: 'Popular Blood Therapy May Not Work' By Gina Kolata Jan 12, 2010.
Unfortunately, it's still seems to be too early in the game to call it, but here's one more clinical trial that was expected to be completed in the Sept. of 2018 but is not showing results at the time of the updating of this article on March 7, 2019.
One of the exciting things about this trial is the inclusion of a "Sham Injection," as a placebo control group.
“At this point, it is unclear whether whole blood, concentrated platelets, or simply passing a ultrasound-guided needle through the abnormal tendon as a means to stimulate tissue healing (tendon fenestration) is the better treatment.”
“The objective of this trial is to compare platelet rich plasma, whole blood, dry needle tendon fenestration, and sham injection (with physical therapy) to identify the best and most cost-effective therapy for this debilitating condition.”
'Comparison of Platelet Rich Plasma and Alternative Therapies for the Treatment of Tennis Elbow (Lateral Epicondylitis)'
My Take On PRP And ABI For Tennis Elbow
As I said in the beginning, this is a medical intervention that I can agree with – at least in theory.
Although there is a point where some sufferers will be faced with the possibility of surgery...
Here's my video on 5 key points to consider when facing surgery for Tennis Elbow
PRP might be a better alternative - or at least a last ditch effort before turning to surgery for cases that just won't respond, as long as there isn't a major tear involved.
I do like the idea of using the body's own material (blood / plasma / platelets) to attempt to “restart” a failed tendon healing process, rather than fighting that process (inflammation.)
But one of my first points of hesitation, is that there's no such thing as “minor surgery.”
Yes. This is a procedure that is “minimally invasive” and the risks of significant negative effects are very low, but whenever you pierce the skin you have risks of infection, and whenever you inject something somewhere – even if it IS your own platelets – there are risks of adverse reaction.
Personally, I don't turn to conventional medicine for even the tiniest, “minimal” interventions unless it's absolutely the last resort – I'm kind of extreme that way 😉
But what about you? What if you could accomplish the same goal as PRP without the stabbing needle, expense (and potential pain!)
Would you mind if it took some regular, daily (or at least several times a week) periods of concerted effort on your part?
The reason I ask is that, from my perspective, the most important strategy for healing a chronic, stubborn tendon problem is to reverse the stagnation.
And the best way to reverse that stagnation (lack of blood flow, lack of normal expected healing response, stuckness!) that I know of is to “work it” regularly, physically – by hand!
I believe very specific therapy techniques are needed to do this properly (which is what I teach members in the program here at Tennis Elbow Classroom, of course)
Here's my video about the 3 best self massage techniques I teach
But any kind of massage / manipulation is better than nothing.
- Not total rest with the absence of all activity…
- (Or rushing too soon into rehab exercises either, which often backfires)
- Not icing it, bracing it and medicating it into submission
- But, instead, getting “in there” and NOT leaving it alone! Not allowing things to stagnate!
I do understand that the thought of manipulating by hand may seem counter-intuitive, and perhaps even a little scary at first.
Doesn't it need to be “left alone” and allowed to rest in order to heal?
No. Absolutely not! – (Except in a few extreme and rare cases where there's a known, major tendon tear.)
And you can learn how to do this yourself - Tennis Elbow is very self-treatable! - You don't necessarily have to go to see a professional therapist like myself (although that may end up being a very sensible option if you can manage it.)
And if you're already at the point after months of struggling with your Golfer’s or Tennis Elbow where you’re actively starting to consider the idea of PRP injection therapy – does it really make sense to go from one extreme to the other?
What I mean is if you've been taking the “total rest and immobilization” approach along with inflammation suppression via pills, ice and shots…
(Perhaps along with some Physical Therapy and exercises on your own – but otherwise allowing a state of stagnation to persist)…
(See also, my article / video on The 3 Key principles Of Rehab Exercise)
And then when that fails, does it make sense to immediately rush to the extreme action of injecting your own blood into your tendons and trying to reverse direction all at once – suddenly encouraging inflammation?
Before you take that radical step, I just want to suggest the idea of moving gradually in that direction:
- By trying heat on the area instead of ice - Yes, heat!
- By using more stretching (the way I teach!) and gentle movement instead of bracing...
- And most importantly, by starting a program of regular hands-on manipulation of your muscles and tendons...
Even if you've already had a professional therapist of some kind work on you with little or no improvement – Because this is something you can do for yourself every single day in a very sustained manner, which is a powerful thing!
You can learn more about my programs, which teach you how to do this, below:
Learn To Treat And Heal Your Own Tennis Elbow Or Golfer's Elbow At Home With This Video Program
You'll get instant access to a complete VIDEO program designed by a professional therapist to help you take charge and break your vicious cycle of pain and frustration!...
I'll be your personal tutor guiding you through step-by-step video lessons, where you'll get the therapy techniques, key stretches and essential exercises you need to treat and recover from your injury at home. (Without any special equipment.)
Just watch the videos, follow along and start putting an end to your elbow pain today, whether you have Golfer's or Tennis Elbow from playing your guitar - or other stringed instrument or ANY instrument, for that matter!)
Tennis Elbow sufferers: Learn more about the Tennis program here
Golfer's Elbow sufferers: Learn more about the Golfer's program here
I believe Nadal has had this therapy done in Spian for his knees. A monster of a tennis player! Would be worth checking out….
Allen Willette, Tennis Elbow Tutor says
Thanks, Gene, I did come across references to Nadal when researching this post but, as you say, it sounds like he had it for his knees and I’m focusing strictly on Tennis Elbow here.
I have had Tennis elbow for about 8 months. Nothing worked so I tried PRP. It was relatively painless and I had a lot of swelling and soreness after the procedure that slowly faded away after 3 to 4 week. At 6 weeks I was 90% healed. I had one more injection 2 weeks ago. The doctor also poked the needle in the tendon a few time to help stimulate healing. The tendon is still sore so at this point I do not think the 2nd PRP has been effective. In a couple more weeks, the doctor advised me to start light exercise and stretching. The tendon at the bone no longer hurts and there is just a dull pain which isn’t bothersome at all. I can also pick up heavy objects in a pinching fashion and there is no pain. The doctor said PRP has been a very successful treatment for tennis elbow, but even then some people do not find relief from it.
Allen Willette, Tennis Elbow Tutor says
Thanks for sharing your experience, SirGolfGod! That sounds like a success!
(To my members and visitors, I just want to point out that he said he had a lot of swelling and soreness after the procedure that took 3-4 weeks to fade: What that suggests to me is that there was a natural, positive, inflammatory healing response to the ‘Acute Trauma’ from the needle itself and the stimulation from the injected PRP.)
Inflammation followed by repair and remodeling – the 3 phases of healing – is what needs to happen for the body to heal any soft tissue injury, including muscles and tendons. Instead of suppressing that natural response with ice, pills and Cortisone shots, PRP Therapy aims to encourage it – and that often results in some swelling and discomfort as the inflammation process kicks in.
The only thing I would add is that I don’t think it’s necessary for most Tennis and Golfer’s Elbow sufferers to go to the extreme of having a needle jabbed into their tendons in order to stimulate a healing response.
Although, I’ll be honest that my program is not for everyone, it’s cheap and non-invasive. I believe you can stimulate your tendons to heal with dedicated self-therapy techniques.
Yes, PRP Therapy looks promising, but I also want to encourage people to consider regarding it as a last resort.
Sally Gordji says
I have the same pain as you had. My Doc sugested prp I just want to know if it was painful since i am scared of injection and if it worked for you.
Pam Mc says
Hi, I’ve struggled with tennis elbow for coming up to a year with periods of some relief.
I’m unable to determine the cause as before the pain began I’d not change activity or intensity. My main exercise is cycling, on the road commuting and holidays, and spin classes. So my main suspect of cause is holding handlebars, jarring or moving positions around the bars. Do you think that cycling is to blame and do you have any suggestions as to how to ameliorate the problem. I try not to grip tightly or bear too much weight through the bars. I’ve had physio, taking note of not icing, sports massage and “aggravating” the area myself.
Allen Willette, Tennis Elbow Tutor says
Pam, Yes, cycling is probably the cause of your Tennis Elbow (although there may be other contributing factors) Static gripping and holding things – especially with added vibration – is a well known risk factor in both Tennis And Golfer’s Elbow injuries. Tension builds up in the wrist and finger muscles in the forearms, which puts an excessive load on the tendons where those muscles originate at the Epicondyles (The Golfer’s and Tennis Elbow “spots”)
I think the most important thing is to release that tension (and the adhesions and sometimes scar tissue) that form in those muscles. Stretching is an important thing to include regularly as prevention to keep the restrictions from building up – but it’s terribly inefficient at breaking the cycle once it has really gotten going.
I don’t know if my program is right for you or not, but I think it might help you a lot. I have great techniques for releasing stubborn muscle tension and adhesions. Here’s what’s in my Golfer’s and Tennis Elbow self-help program
(Otherwise, just do your best to massage and release your muscles as best you can.) You might also want to look into your Rotator Cuff and scapular stability. A lot of forearm tension can be traced to instability in, and compensations related to, the shoulder. That would definitely be a possibility with your cycling.
Luke Thomas says
I’ve had really bad tendinitis right on the bony part of my left arm for around 10 weeks.
I believe it was caused by having 6 months off from weight training and then suddenly getting back into it. I initially took 3 weeks off training and had electrical stun and acupuncture therapy as well as massage, gaston? By the chiro and aggressive icing (first two weeks) followed by aggressive heat therapy (last week) all this while taking Celebrex. After 3 weeks rest I noticed I still had discomfort while resting and outright pain while gripping an object slightly heavy (coffe jar). I’ve spent the last 7 weeks trying the “flex bar” and massage therapy along with regularly applying linemen tools and heat packs. I feel the pain is now worse as a result of these actions? Any suggestions? I am considering a cortisone shot as PRP is too expensive,
Hi, I had a PRP injection on Thursday. It was so excruciating that I passed out from the pain. I could not make it home and had to call for my husband to collect me. 3 days later and I still cannot bend my hand to touch my face or straighten my arm. I need assistance with everything from dressing myself to doing my hair. I was told it would be uncomfortable for a up to a week, then it gets better. I am absolutely useless now. I can’t even open a ziplock bag. I am a pastry chef with expensive upcoming weddings to cater for and I’m terrified. I cannot work, drive, make dinner for my children, play sport or sleep. Does this sound like the doctor has done something permanently wrong, or I am just unlucky?
Allen Willette, Tennis Elbow Tutor says
Hi Leah, I’m sorry to hear you’re in so much pain. PRP is inherently a very painful procedure when performed without anesthetic, (which it often is!) And often quite painful for 1-2 weeks afterward. “Uncomfortable for a up to a week” seems like a bit of an understatement, from what I’ve heard.
If I were you, I would probably not be worrying that the Doctor did something wrong at this time so soon after the injections. I can’t really say for certain one way or the other, of course, but it sounds like you might be having a fairly common experience. I encourage you to get back in touch with the clinic if you have doubts, though.
Hi. I’ve had golfer’s elbow for 6 months and it’s just not going away. I’d been considering PRP for a little while before I read your post. Even though I had been massaging my elbow somewhat on a regular basis I tried upping it by really focusing on the tendon (it was painful to massage). Well, since I’ve been doing that (once a day for about a week) my elbow has gotten much worse. I haven’t massaged it the last 2 days as it’s too painful. What I wanna know is that is this an expected thing? There is tons of inflammation now, is that a good thing? How should I go about massaging it now? Wait till it’s calmed down? It’s quite hard to figure out how to go about trying to treat this thing, so many different opinions!
Allen Willette, Tennis Elbow Tutor says
Gio, I would guess that once a week working directly on the tendon may be too much for you at the moment and perhaps you’re working it for too long at a time. 5-10 minutes is often enough.
You may be in need of more recovery time – Maybe even a couple of days in between sessions – but it is to be expected that these tendon problems can become pretty irritated, especially in the beginning – especially if you’re switching from a conventional “Suppress, Immobilize and Cool” / S.I.C.k approach to a “Mobilize, Warm and Allow” approach.
But don’t worry about “tons of inflammation” unless the area gets swollen (visibly puffy) or red. It may be a good thing if your tendon has been degenerating and now it’s starting to heal, which means inflammation: The 1st step.
You’re not following my program, though, are you? (I couldn’t find you in the members’ area.) I’m wondering if you have the best Golfer’s Elbow therapy techniques.
Hi Allen, thanks for the reply.
I was using the S.I.C.k approach you mentioned for the first month but came across your site and started to follow your advice immediately (with the help of some youtube videos).
I started with massaging and stretching the tendon (massaging was definitely helping), but unfortunately soon after I developed golfer’s elbow in my other elbow too and so had no option but to alter the way I massaged the tendon. I had to start using a lacrosse ball on a table top, which was definitely not as effective and wasn’t properly targeting the tendon.
I then slowly added exercises to my rehab program, and it seemed to be going fine until recently when the pain levels started to increase quite a bit. I eventually decided to stop the exercises but carried on with massaging and stretching, which was when I tried to tweak my massage to focus more on the tendon again, but this caused it to flare up even more.
Now, I haven’t performed the tendon specific massage for a few days and it has eased up slightly. I’ll try doing it every 3 days or so for now and see how it feels. I haven’t noticed any swelling or redness since the recent flare up which is good. I don’t plan to start the exercises again until it feels a lot better.
Regarding your program, I just saw that you have now released a golfer’s elbow program (I don’t think it was available a few months ago). I’ll look into becoming a member if my symptoms don’t get better soon.
I’m posting a positve response to a PRP injection, because it can be an effective if somewhat painful procedure. I had one PRP injection for my tennis elbow in my left, non-dominant arm, and it was a success after 6 weeks of babying it (doing only the stretches prescribed) and 8 weeks of physical therapy. Completely healed.
I’m now undergoing my second PRP injection for golfers elbow, which my doctor told me did not have as good a result in studies as it did for tennis elbow. The first injection got me about 75% healed. Certain movements were vastly improved while some specific movements were still painful. It felt like the healing process had stalled out about 4-6 weeks into physical therapy.
I just had my second injection this morning, so I can’t say if it will be successful in completely healing my golfers elbow, but I’ve had positive reactions to previous injections and was willing to try one more round in order to avoid surgery. The pain can be intense the first few days and sore for about 7-10 days after the injection, but it’s much better than dealing with surgery. My injections were about $400 each and were not covered by insurance.
It needs to be treated like a minor surgery with PT after a period of healing. I know some guys who went right back to their gym workouts after getting injections in both elbows and they did not have good outcomes. I wanted to provide a positive outcome for tennis elbow injections, because it could work for others like it did for me. Jury is still out on the golfers elbow.
Allen Willette, Tennis Elbow Tutor says
Hi Megan, I certainly welcome your positive response! Glad to hear PRP worked for your Tennis Elbow (and I hope it also does for your Golfer’s)
I definitely agree with you, that it needs to be regarded like a minor surgery with PT after a period of healing.
(And I’m looking forward to hearing about anyone’s experience who decides to have PRP, and then chooses to use my self-help program(s) as part of their rehab process afterward.)
I’m going for my first prp injection on the 20th oof this month..(lm a little nervous about it) my question is simple …im a welder by trade …would i be able to return to work the next day and do my work
Allen Willette, Tennis Elbow Tutor says
Hello Gilles, I wish I could answer that for you, but I don’t know. That would really be a question for the Orthopedist who is going to do your injection. (All I can tell you is that a lot of people report that it tends to be even more painful for a week or so after the PRP injection.)
I tried PRP (sessions, multiple injections into each elbow) – it provided only temporary relief, maybe a monrth or two after each injection, but no long lasting effects.
And yes, during the first week or so, the pain gets worse, and it’s not the inflammation due to the needle in the skin.
I am in need of your advice and have found your site very helpful so far. Though, I think my case is possibly somewhat unique and I’m hoping you could help me out and that this will be informative for the rest of your audience.
Back in June, I strained my elbow and struggled with what felt like normal lateral epicondylitis for almost two months before seeing an orthopedic surgeon who gave me a cortisone injection. It felt great for approx. 3-4 weeks and then one day I felt a sharp pain in my elbow and returned to the doctor to find out from an MRI that I had a 50% tear of the superior lateral portion of the common extensor tendon.
I’ve spent the past month doing stretches and light exercises along with some icing with no to very little improvement. Just yesterday I had a PRP injection and to confirm everything you and the other posters have mentioned, it was very painful and is still very sore on day two.
My question is, if the PRP hasn’t helped by my follow-up in 4 weeks, what should my next course of action be? The orthopedic surgeon told me that he doesn’t usually pursue surgery unless someone have been dealing with this for 6 to 12 months. I work in emergency services and I really can’t be on light-duty for 6 to 12 months while I wait to see if this thing heals or not. And I know I’m in the middle ground with the tear being 50%. Is this a case where you would recommend surgery? And if so, could you possibly suggest which surgery is best? The ortho told me there are 20 different surgeries for lateral epicondylitis and the most common one I’m hearing just seems to be going in and cutting out the damaged portion of the tendon and not really doing any sort of repair. Though, I have seen those where they put an anchor in the lateral epicondyle and suture the tendon to the bone.
I would so greatly appreciate your input and advice! I really want to get back to work as a firefighter as quickly and safely as I can.
Allen Willette, Neuromuscular Therapist says
I can’t advise you directly on whether to have surgery or not (or what type. I’m no expert when it comes to different surgical techniques.) I can refer you to my article on:
When Is It Time To Consider Tennis Elbow Surgery?
Hope that helps!
(And just because you have tears does not necessarily mean you will automatically be in chronic pain forever. You may still be able to strengthen the healthy part.)
Here’s an article on my site that might be helpful, explaining that concept of strengthening the “good part” of the tendon:
I injured my arm after moving in the same matter but lifting a heavy item and twisting it. I got 1 prp injection into my left elbow in March 2022 & it’s now June 2022. I still have pain: pain when resting at times, swelling after sleep, pain when lifting/grabbing/reaching & swelling in my fingers. Now there are days when the pain is dull when lifting but then there’s pain sometime after. One day I can lift a jug of milk with dull pain but then there is a day with more obvious when lifting a jug of milk.